Hyperprolactinemia and infertility.

Hyperprolactinemia (hyperprolactinemia) is Lactagogue blood hormone (PRL) higher than normal. Now that it includes more dominant high prolactin and potential hyperprolactinemia. The former refers to PRL 24h blood continues to rise potential means sleep at night PRL exceeds the scope or physiological cycle of a period of a transient increase. ??Etiology and morbidity -- Lactagogue secretion of pituitary hormone (PRL) is largely due to normal hypothalamic secretion of dopamine (DA dompamine) inhibitory regulation. Thyrotropin-releasing hormone (TR Thyrotropinreleasing hormone H), Vasoactive Intestinal Peptide (VIP Vasoactive intestinal VIP) promote PRL secretion. Besides estrogen, sleep, breastfeeding, pregnancy, exercise, sexual intercourse, stimulating factors may also increase the secretion of PRL. When inhibiting factors secreted by lifting or contributing factor role, there will be abnormal increase of PRL secretion, and to produce the clinical symptoms. 1. Chiari - Frommel remit is a long time after childbirth and lactation amenorrhea, may be due after childbirth hypothalamic dysfunction, DA secretion caused by the shortage. Japan's Saitama save hypothalamic-pituitary dysfunction National Statistics study class with 1,543 cases, the incidence of symptoms 13.4%. 2. Argonz - del castillo Syndrome is not producing unmarried women there galactorrhea and amenorrhea. but the merger pituitary tumor. Its incidence of 16%. 3. Since pituitary adenoma CT and MRI diagnosis of universality, in the diagnosis of pituitary adenoma has been relatively easy, high PRL hyperbilirubinemia pituitary adenoma share up to 32.9%. 4. Primary hypothyroidism hypothyroidism when T3, T4 secretion reduced, the role of negative feedback, so TRH secretion increased TRH not only the increase of TSH secretion of PRL secretion also increased, a high PRL hyperlipidemia. 5. Drug effects of certain anti-hypertensive drugs, psychotropic drugs the treatment of gastrointestinal ulcer drugs can inhibit dopamine to the Palestinians over the conversion, the inhibition of dopamine receptor to promote the role of PRL secretion. 6. Postoperative chest hidden dangers chest, intercostal neuralgia, 4-6 thoracic nerve was stimulated, reflection and lactating same mechanism can PRL secretion was increased. ??-- A clinical symptoms. Breast milk secretion of the milk check cent higher secretion of PRL 72.5% of hyperlipidemia. Breast examinations suggest the importance. Other diseases caused by milk secretion rate, Chiari - Frommel syndrome was 97% pituitary adenomas followed at 83%, Argonz - del castillo Syndrome to 74% Primary hypothyroidism only 26%. Milking the emergence rate and blood PRL levels irrelevant. PRL levels high, but it may not have milk secretion, the contrary is slightly higher PRL levels can be seen milk secretion. 2. High PRL menstrual abnormalities in patients with hyperlipidemia menstrual the incidence rate of about 70% and dilute the menstrual 9.0% without ovulation and luteal menstrual dysfunction all around 5%. A normal menstrual cycle of 8.8%. The disease causes the proportion : pituitary adenoma with the incidence of menstrual up to 94.1%. Primary hypothyroidism and drug-induced high PRL hyperlipidemia were no incidence of menstrual less, about 40% to 66%. PRL blood without value and the incidence of menstrual close at 100ng/ml 25 ~ 58% 101-300ng/m1 at 86.7%, 95.6% above 30lng/m1 absence of menstruation. We can see no incidence of menstrual with PRL value increases. Looking at the types of non-menstrual, 95.8% of secondary amenorrhea, primary amenorrhea only 4.2%. 3. Infertility high PRL hyperhomocysteinemia pituitary LH secretion pulse decreased or disappeared. preovulatory LH estrogen-induced feedback mechanism is the obstacle. The hypothalamic GnRH secretion by inhibiting function, thus affecting the gonad axis function, anovulation, resulting in infertility. 4. Other obstacles primary hypothyroidism when l / 3 of patients will goiter. The hypothalamus, pituitary tumors adjacent ears, there may be side heminopia, poor eyesight and other symptoms. PRL stimulate adrenal cortex thus producing an excessive amount of dehydroepiandrosterone (DHEA), resulting in more hair. ??-- A diagnosis. The diagnostic and medical diagnostic use should include whether the treatment of digestive ulcer, central nervous system diseases, hypertensive disease drugs and medication time. A low of chills, dry skin, reduce sweating. After childbirth nursing time? Whether abortion, premature? Whether the vision and visual impairment? When newly diagnosed breast examination must have milk secretion. Chiari - Frommel Syndrome largest milk secretion, other patients generally would require only a squeeze milk secretion. Using progesterone Watch for withdrawal bleeding, pituitary adenoma patients more for the second-degree amenorrhea. 2. PRL blood values measured by RIA blood PRL value over lnmol / L can diagnose this disease. When pituitary adenoma PRL higher value. 3. CT or MRI Sella photography blood PRL value 4nmol / L or accompanied by headache, visual disturbances, heminopia other suspected pituitary lesion should be recommended for patients CT or MRI Sella photography. 4. Potential hyperprolactinemia diagnosis of the disease in two ways; One night measuring blood PRL value, but in actual work done is difficult; The second is for TRH test, TRH intravenous bands, the former administration PRL base value lnmol / L, and 15 min after administration 30min blood test PRL, If it exceeds 5nmol / L can make the diagnosis. ??Treatment (1) of pituitary microadenomas (Mieroadenoma) is adenoma <10mm> lOmm pituitary adenoma. Now that only received drug therapy is difficult to narrow the exact tumor effect, the claim should be the first choice of therapy. But after the operation PRL value normal ovulation rate and the rate was only 5% and 27.3% after giving Bromocriptine PRL value normal rate of up to 90.9%, nearly ovulation rate 54.5%. 2. High PRL function hyperlipidemia (1) Bromocriptine is a dopamine receptor agonist, thus inhibition of PRL secretion of pituitary cells. Medication 2.5mg inhibiting effect of PRL secretion up to 12h. After ovulation rate of 50% to 80%, the treatment three months after ovulation rate up to 90%; the pregnancy rate of 30% ~ 60%. Delivery should start small dose, and periodically measured PRL value gradually increased, find PRL maintain a normal level of volume, and continued use. Such treatment by three months if no additional ovulation can be used clomiphene or application HMG - HCG treatment. (2) TCM therapy; Application rat pituitary cell culture system proved Chinese Peony, licorice roots, roots, Bajitian significantly inhibited PRL-secreting pituitary cells. Clinical application of the four Chinese medicine granules PRL treatment of hyperlipidemia high efficiency up to 80%. (3) Other : low thyroid function caused by high PRL hyperlipidemia first to use thyroxine treatment, if treatment is still high PRL, lactation can continue to increase with bromocriptine. By thyrotropin-releasing hormone (TRH) test can diagnose potential hyperprolactinemia may be a small one to vote for Bromocriptine .25 mg to 2.5 mg / d.